Ensuring Patient Care Does Not Fall Through The Cracks

I always seem to have a small following of patients who have fallen through the cracks of health insurance coverage. My practice policy is “No Financial Barriers to Care.” In other words, we take care of them and provide care according to their needs. Dean was a perfect example of a patient falling through the cracks. He presented in my office seven years ago with a crushed foot. He was trying to move a bull into a corral and a beast that weighed around 800 pounds stepped on his left foot. Dean was 63 years old and had stopped working because of his diabetes and chronic obstructive pulmonary disease (COPD). He was not old enough for Medicare and had no insurance coverage. He still had a crushed foot and, upon further examination, he had a large neurotrophic ulcer on the plantar aspect of his other foot. I explained my proposed care plan for the crush injury and the ulcer. Dean said, “This is kind of awkward, doc, but I ain’t got income and can’t afford your services.” I explained my no barriers policy and we started the care of his injury and ulcer. Dean became a favorite patient in our clinic. He got to know all of the staff by name and always stopped to visit them during his appointments. He became a favorite grandfather figure to my staff. He became eligible for Medicare when he turned 65 and proudly announced that I could make up for all the free care by double billing. I told him I valued my freedom too much to pull that stunt. He frequently needed costly medications and supplies for the treatment of his ulcer. The staff would beg the pharmaceutical firms to provide the medications for Dean at no cost. He was always gracious and appreciative for these favors. On his last visit to my office, Dean’s COPD was severe and he could hardly breathe. His ulcer had not improved after years of care. He admitted that he was worn out and ready to give up. I attended his graveside service last month. His friends called to let me know of his death and they hoped I could attend his service. Since he had always appeared to be a loner, I assumed there would be a small number of mourners. When I pulled into the country cemetery, there were no mourners. There was a large crowd of friends gathered around Dean’s modest cloth-covered casket, telling humorous stories about him. I was late for the service because the isolated cemetery was difficult to find. It overlooked the Cowlitz River, which has always been a favorite fishing spot for Dean and me. I approached the gathering and they stopped telling stories to greet me. It turned out that Dean let many people know about the years that I provided free care for him. I felt very welcome among his friends. My turn came to tell a Dean story. I told the crowd that in the eight years I was Dean’s foot doctor, he never made it to an appointment on time. I told them I now have the last laugh by being late for his funeral. I also told them it surprised me that he had made it on time. When the service ended, his friends wandered back to their various dilapidated cars and pickup trucks. I walked over to Dean’s casket to say goodbye. An elderly woman came up to me and asked if I remembered her. I did not. She introduced herself and told me she was Dean’s girlfriend. She also reminded me about the time I took care of her deceased husband who also fit the fallen through the cracks group. She invited me to a gathering at Dean’s home and asked if I could give her a jumpstart since her car battery was dead. I dug out my jumper cables and got her going. Then I followed her to Dean’s place. Dean’s home was on a small farm. His house was surrounded by old trailer houses. Children and dogs were everywhere. Dean’s girlfriend explained that Dean owned the trailers and that the families were strays (homeless) that he had gathered. Most lived there rent-free. It gave me a warm feeling to know that this man, who I had helped when he fell through the cracks, had helped so many other people himself. The impressive part was that he never talked about it. My office staff and I will always miss Dean but will always be blessed with other patients like him who seem to have fallen through the cracks. Dr. McCord is a Diplomate of the American Board of Podiatric Surgery. He practices at the Centralia Medical Center in Centralia, Wash.